The POTScast Excessive sleep, fatigue and insomnia in POTS WITH Dr. Kirti Sivakoti
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Mar 17, 2026 Dr. Kirti Sivakoti, pediatrician and dysautonomia expert at the University of Utah, discusses sleep problems in POTS patients. Short sentences cover excessive daytime sleepiness versus fatigue, why insomnia is common, and how autonomic dysfunction fragments deep sleep. She talks about when to try home strategies, CBT-I, sleep studies, and medications, plus practical morning routines and treatable contributors like low ferritin.
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Sleep State Misperception Is Common
- Subjective sleep perception in POTS often mismatches objective measures (sleep state misperception).
- Actigraphy studies showed patients report longer sleep-onset latency than measured, so naps may be shorter than they think yet still disrupt nighttime sleep.
Use CBT-I And Limit Naps
- Use CBT-I techniques and limit naps to restore nighttime sleep timing.
- Aim for short naps (20–30 minutes) and restructure environments and thoughts that reinforce long daytime sleeping.
Treat POTS Drivers Before Sleep Study
- Before ordering sleep studies, aggressively treat POTS contributors like low volume, palpitations, pain and low ferritin.
- Correct volume with fluids/salt/compression and aim ferritin toward 75–100 ng/mL in symptomatic patients.